Health Care Reform Should Focus More on Quality Care Than Access

Posted on March 18, 2010


Incredible insight into the health care reform question . . . a Doom Loop versus Fly Wheel approach . . . the real issue has nothing to do with partisan sensibilities but instead with the quality of health care under Medicaid.

During today’s broadcast with Maine’s Republican Gubernatorial Candidate (and the latest thought leader to join our popular Business Thought Leaders Series) Matt Jacobson, the kind of epiphany that transforms a complex issue into a practical understanding occurred during our discussion on the growing controversy surrounding health care reform.

Candidate & Thought Leader Matt Jacobson

Specifically we should not prioritize access over quality. In this light, here are a few facts that you will find interesting:

1. According to statistics “more than 4 percent of patients ages 6 to 17 in Medicaid fee-for-service programs received anti psychotic drugs, compared with less than 1 percent of privately insured children and adolescents.” While this is the single biggest drug expenditure for Medicaid, costing the program $7.9 billion in 2006, the real issue is that anti-psychotic drugs are powerful and have a list of side-effects with which an adult, let alone a child should not have to deal. Yet under Medicaid children are 4 times more likely to receive these drugs.

2. We all know that actor Corey Haim died this past week. What just broke on the news-wires is that officials have just made an arrest in a probe linked to his death that was tied to a prescription drug ring.

Having “identified an unauthorized prescription in the late actor’s name,” statistics show that prescription drugs are becoming the choice drug for youths because of accessibility. A poorly managed health care program which makes prescription drugs more readily available can only exacerbate the problem.

What was interesting about Matt’s viewpoint, is that he does not question the importance of all people having access to “good quality” health care (emphasis on good quality), but in how it is being managed.

The pregnancy test example he provided spoke volumes. Specifically, under the current government subsidize/managed program in Maine, people are more inclined to have a test done through a medical facility that costs $300 to $400 versus going to the drugstore and paying $15 for a pregnancy test.

Access therefore is not the issue, access to a well-run program is. Therefore, the real question becomes simply this, who is better equipped to run a health care program . . . government or private industry.

Based on the disparity between the children who are prescribed anti-psychotic drugs and those who are not, as well as the proliferation of prescription drugs, the answer is pretty clear.

Still not convinced that both quality and effective management of a reformed program should be the focal point of health care in America versus a myopically focused vision of universal accessibility?

Hospitals in Maine receive 70 cents on the dollar when they treat a patient under the State’s MaineCare Health Program. Put aside for a moment the fact that those who can afford medical coverage, pay a premium for the same care through the same hospital to cover this discrepancy, the real issue is the fact that the State is slow to pay the hospital for the services it has rendered to a MaineCare patient. In fact according to Matt, and due to being in a perpetual budget crisis, it can take the State between 3 to 5 years to reimburse the hospitals for the services they provide.

What impact does this have on a hospital’s ability to operate effectively?

As indicated, in the end the issue of health care reform has little to do with the incendiary issues of partisan politics or rights of access, but instead should be squarely focused on creating an effective, properly managed program.

What are your thoughts? I both welcome and encourage your feedback.

In the meantime, and if you did not have the opportunity to tune into the live broadcast you can access the On-Demand version through the following link “Thought Leaders Segment: Health Care Reform with Matt Jacobson.”